55 A REPORTER AT LARGE T HERE seems to be no more persistent and serIOUS preoccupa- tion in the art and thought of our time than the idea of madness-perhaps because, in our century, definitions of sanity have been so carefully posed, and so drastically called, by events, into question. In purely psychoanalytic terms (sanity as freedom from crippling dis- orders of reason), or even in the toler- ant, anthropological view (sanity as an adjustment to the consensus of one's own communiq ), too man} twentieth- century personalities,---Eichmann and Gandhi, for example-may turn up on opposite sides of the border from where we should care to place them. In times when moral and social values are under stress, it is nearly impossible to tell in what an unsound mind can possibly consist. Hallucinatory states, ethically monstrous acts, radically eccentric or suicidally impractIcal behavior-each of these formerly clear symptoms of mad- ness is now, for some part of the com- munity, a socia] norm The words "mad" and "insane" themselves have passed out of pathology and into the world of fashion; without a broad con- sensus, or word from a higher spiritual authority on what is right, it is impossible to be cer- tain who is sane. There is less ambiguity in cases of physical disorder, where it is relatively easy to determine who is sick and who is well, but even in physical medicine there are hor- derline cases: the allergic, for example, whose "disease" is, after all, only a symptom of excessive health-a heightened physical perception. In the case of those who are not sick or in- sane by any standard but only disaffected or troubled in their minds, the problem of whether and how they are to be treated-and, above all, whose responsibilit) it is to decide, and dIagnose, and treat them-be- comes of vital importance; for nothing defines the qua1ity of life in a community more clear- ly than people who regard themselves, or whom the con- sensus chooses to regard, as mentally unwell. The kind of treatment that the troubled in search of profes- sional help have been getting has, by all IndicatIons, not been good. THE THUR.SDA Y GR.OUP Although the nature of the problem makes it difficult to compile statistics (human misery in a free, affluent, and secular societ} is hard to quantify), two recent studies on the subject- "The Effects of Psychotherapy," by H. J. Eysenck, which appeared in the In- ternational ] ournal of Psychiatry, and a survey by Harry Weinstock, which was prepared for the American Psychoana- lytic Association and never published anywhere-reveal no appreciable dif- ference between people who have un- dergone psychotherapy and people who ha ve not, and no statistical evidence that psychotherapy does patients an} good at all. It is true that increasing numbers of patients feel relieved by therapy, for they continue to seek it, and there are many case histories of patients who apparently have been cured, since symptoms that existed when they began treatment had dis- appeared when they terminated it. The same claims, however, are probably -f " :! ! l< :. \1\ t }. t r,.,. f-, ''ti'f ., - \Tð1W I Li ". ,.. "'t ' , . -. ;I \ sf 1 Þ ,\ ! Jt / , " A "'tf '. , . '" *" '& ( f " .. .... :I>."t ," .", J -';" I " þo(,,>>,-, - ".- 19 -.", made with more validity for other, non-scien tific, approaches to emotional disorder-notably friendship, prayer, ritual, the laying on of hands, and the passage of time. The religious compari- son, in particular, has been reinforced by the intolerance or indifference with which members of the various schools of psychotherapy often regard one an- other's work; professionals who deal constantly with the troubled seem to find it difficult to communicate on an equal hasis with observers from other disciplines or colleagues within their own. Psychiatrists quite commonly treat (and charge) observers as though they were patIents, and intradisciplinary con- ferences in psychotherapy more closely resemble ecumenical councils than free exchanges of scientific in for mat ion among peers. In addition, there is the peculiar problem of appraising a "cure," or successful outcome, for mental dis- order In the first place. With what are generall) termed psychotics-schizo- }J I '1 :.0( I I f ,. " ' '> . 4- "" ' i "'<- "- "-\ . .' .r .... " \ 4 f /' "-. < \jj,. , \ I y i y 1 f \ f , , j <1 > " ! ; it "' fþ . I {, fttl 1 I' ;" -- 1 I J f $:':' ì\ . j ' '.1 "" t " ø-' ' , 't' , -------'" x... (IV , If. .. / ,, . ' ?<> .. < y' M.." . . ,